Jim Morrison once sang;
Five to one baby, one to five, no one here gets out alive, now you'll get yours baby, I'll get mine, Gonna make it baby, if we try, the old get older and the young get stronger, may take a week, and it may take longer, they got the guns, but we got the numbers, Gonna win, yeah we're takin' over. The AMA reported that complex spine surgeries that rely on hardware are on the rise, resulting in more complex and costly procedures. So the question must be posed, is there data that substantiates better pain relief or function with more complex spinal procedures?
Medicare patients undergoing spine surgery fell during the period from 2002-2007. This was driven by a decrease in the rates of pure decompression surgeries. However, during this period there was an increase in complex fusions utilizing pedicle screws, rods, cages and biologics. The highest risk for major complications was observed in complex fusions, in addition, higher hospital costs were associated with these procedures.
What has surfaced is that there is a need for more evidence regarding the efficacy of these surgeries, especially, lumbar stenosis. One author stated, "it seems implausible that the number of patients with the most complex spinal pathology increased 15 fold in just six years. The root cause of this problem is diagnosed by Dr. Eurgene Carragee of the Standford University School of Medicine who states, "...devices are aggressively marketed, so much so that there promotion may sometimes cross the line of professional conflict of interest among profession leaders and institutions." Complex fusions are more profitable for surgeons because reimbursement is significantly higher.
So in closing, TSB must ask our readers, "Are surgeons performing more complex spinal fusions?" And, "are we seeing procedures that compromise an ethical obligation to patients in lieu of monetary rewards?" TSB wants to know what our readers think?